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At least 1,387 records · Page 77Linked to original sources
PubMed1989

Calcium and other biochemical alterations induced by masseter spasm following suxamethonium.

Calcium and other biochemical disturbances are reported from the plasma of a child which presented masseter spasm following the administration of suxamethonium during the induction of halothane anesthesia. After masseter spasm, the ionized calcium concentration decreased whereas the total calcium level remained unchanged despite the occurrence of metabolic and respiratory acidosis. Throughout the rest of anesthesia, the total and ionized calcium concentrations continued to decrease. These variations may indicate that complex metabolic and biochemical events influenced the calcium binding to albumin and the calcium transfer into the muscle cells.

Biological Transport↗
PubMed1986

Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease.

When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. beta-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.

Adrenal Cortex Hormones↗
PubMed1989

Plasma arginine vasopressin response to intravenous methadone and naloxone in conscious dogs.

The effect of naloxone and methadone on the systemic release of arginine vasopressin (AVP) was studied in six conscious dogs. After i.v. methadone administration (1 mg/kg b.wt.) plasma AVP levels rose significantly to a mean maximum value of 102.8 +/- 18.8 pg/ml at 15 min postinjection. Plasma sodium and plasma osmolality did not change significantly, whereas plasma potassium decreased significantly. Blood gas variables showed the development of a slight respiratory acidosis. Mean arterial blood pressure increased and heart rate decreased, both significantly, after methadone administration. Naloxone (0.1 mg/kg b.wt.) administered i.v., 15 min before methadone, prevented the changes in plasma AVP levels as well as other variables, with the exception of the heart rate. Naloxone administration itself did not induce changes in any variable recorded. The dose-response study showed increasing plasma AVP levels upon administration of increasing doses of methadone above the 0.5 mg/kg level. On account of the magnitude of response and the lack of changes in biochemical and hemodynamic variables sufficient to explain the documented AVP response, we conclude that methadone exerts a stimulatory influence on the systemic release of AVP. We consider the documented release of AVP to be a direct effect of the methadone administration, on account of the findings from the dose-response study and on account of the total blockade of the response after naloxone administration before methadone.

Animals↗
PubMed1989

Clinical studies of fish blood: importance of sample collection and measurement techniques.

Effects of blood sample collection and measurement techniques were assessed for blood gas tensions, acid-base status, and hematologic and plasma biochemical values of rainbow trout. Blood samples were collected via intraaortic cannulae from immersed, unrestrained fish and from emersed, restrained fish. The samples were analyzed at either fish body temperature (10 to 14 C) or clinical blood analyzer temperature (37 C); results obtained at 37 C were back-adjusted to fish body temperature, using standard mammalian temperature-correction factors. Fish emersion and handling for 30 seconds significantly (P less than 0.05) altered blood PCO2, acid-base status, and hematologic and plasma biochemical values. The results were consistent with respiratory acidosis and hemoconcentration. The use of mammalian temperature-correction factors for determination of fish blood gas tensions and acid-base status yielded values that were significantly (P less than 0.05) different from those measured directly at fish body temperature.

Acid-Base Equilibrium↗
PubMed1986

[Hemodynamic interaction between midazolam and alfentanil in coronary patients].

We studied the hemodynamic interaction between midazolam and alfentanil during induction of anaesthesia in 27 patients with coronary heart disease. Using alfentanil alone (93 +/- 6 micrograms/kg) the induction was associated with stable systemic haemodynamics but also with a pressure increase in pulmonary circulation, due to chest wall rigidity and respiratory acidosis. The administration of subhypnotic doses of midazolam (50 and 100 micrograms/kg) prior to alfentanil prevented chest wall rigidity and pulmonary vasoconstriction completely, suppressed the pressor response to intubation and reduced the dose of alfentanil required for induction. However the midazolam-alfentanil combination led to hypotension, which was primarily due to a decrease of peripheral systemic resistance. Thus the haemodynamic interaction between midazolam and alfentanil resembles the known interactions between other benzodiazepines and opiates, characterized by decreased sympathetic tone and suppressed baroreceptor reflex.

Alfentanil↗
PubMed1987

Skeletal muscle thermogenesis: its role in the hyperthermia of conscious rats given morphine or beta-endorphin.

The role of skeletal muscle thermogenesis (increases in skeletal muscle tone) in the hyperthermic responses of conscious, unrestrained rats given acute or repeated i.p. or i.c.v. injections of morphine sulfate (MS) or beta-endorphin was investigated. Initial blood gas experiments showed that rats given acute i.p. injections of MS caused PO2 and pH to decrease by 60 min postadministration in a dose-related fashion whereas PCO2 increased; with repeated MS administration the respiratory acidosis seen with acute injections was reduced. Acute i.p. injections of MS (1, 10 or 20 mg/kg) caused catalepsy scores, plasma lactate levels and electromyographic (EMG) amplitude to be elevated in a dose-related fashion along with a rise in rectal temperatures (TRS). Surface (tail) temperatures also rose after the acute MS injections but only after the increase in TR. Significant increases in EMG amplitude after acute injections of MS occurred even before TRS increased and, with subsequent naloxone HCl administration (10 mg/kg i.p.), a rapid and marked fall in EMG amplitude occurred before TRS fell back to saline control levels. Acute i.c.v. injections of 1.1 nmol of either MS or beta-endorphin also caused EMG amplitudes to rise significantly before TRS began to increase. Tail temperatures again increased passively after i.c.v. injection of either drug. Subsequent naloxone injections (10 mg/kg i.p.) to these groups also caused EMG amplitudes to decrease before TRS decreased back to control TRS. Repeated i.p. injections of MS (10 mg/kg i.p. daily for 5 days) caused TRS to be higher than those seen after the initial injection but catalepsy scores, plasma lactates and EMG amplitudes were below those respective levels seen upon acute MS administration. Similar chronic findings occurred in other groups of rats given 1.1 nmol of either MS or beta-endorphin i.c.v., when they had been previously given repeated i.p. injections of MS (5 mg/kg i.p. twice daily for 2 days). The results indicate that acute peripheral or central injections of MS or beta-endorphin to conscious rats cause skeletal muscle to be activated, resulting in nonlocomotor, catatonic behavior. This skeletal muscle activation occurs before the rise in TR and is thought to be an important and possibly the primary cause of the resultant hyperthermia seen in rats after acute central or peripheral administration of MS or beta-endorphin. Repeated injections of morphine cause TRS to escalate higher, compared to that seen with acute MS administration, yet catalepsy scores, plasma lactate levels and EMG amplitude changes did not increase likewise.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

Hemodilution and autotransfusion in pediatric cardiac surgery.

Better understanding and advances in the management of neonates undergoing cardiac surgery have increased their survival. Twenty neonates were studied to evaluate the technique of acute hemodilution in open cardiac surgery. They were premedicated by rectal barbiturate, anesthetized and monitored for all vital signs and blood chemistry. Patients operated upon with hemodilution suffered less respiratory acidosis during bypass. They showed marked drop in pH which was rapidly corrected in the postoperative period. No significant change in blood pressure from the expected was observed. These neonates (with hemodilution) had more tendency to fluid retention, which is not of appreciable clinical significance. The technique of acute hemodilution in neonates undergoing open cardiac surgery with extracorporeal circulation proved to be successful.

Anesthesia, Inhalation↗
PubMed1987

The clinical pathology and pathophysiology of heartwater: a review.

This paper reviews the available literature on the clinical pathology and pathophysiology of heartwater and makes comparisons with unpublished results obtained from a recent study in experimentally-induced heartwater in calves. The pathophysiological changes seem to center on an increased capillary permeability the result of which is reflected most noticeably in cardiac and lung function. There is a marked drop in cardiac output in severe cases and some workers have recorded a severe drop in diastolic blood pressure in the advanced stage of the disease. Changes in lung function are variable, depending on the stage of the disease, and may change from a respiratory alkalosis in the early febrile stage to a respiratory acidosis in more advanced cases. The basic cause for the increased capillary permeability is not known. The main clinical pathological changes measured include a progressive anaemia, fluctuations in total and differential white cell count, of which an eosinopenia and a lymphocytosis are the most marked, increases in total bilirubin which coincide with darkening of plasma colour, and a drop in total serum proteins mostly shown in the albumin levels.

Animals↗
PubMed1988

Cricothyroid membrane puncture: oxygenation and ventilation in a dog model using an intravenous catheter.

A method for pediatric airway support was evaluated for the situation when mask ventilation or intubation is impossible. Mongrel dogs were sedated, intubated, and allowed to breathe room air for 30 min. Baseline variables were recorded, and the airway obstructed. After 2 to 3 min of hypoxia, arterial blood gas and hemodynamic data were again recorded. A percutaneous cricothyroid membrane puncture (PCMP) was then performed with a 12-ga iv catheter. Studies were carried out both in the presence and absence of spontaneous ventilatory efforts. With spontaneous ventilation, continuous low flow (1.0 L/min) oxygen insufflation provided oxygenation for 30 min and reversed increases in mean arterial pressure, pulmonary artery pressure (PAP), and systemic and pulmonary vascular resistance that had been produced by the obstruction. Respiratory acidosis occurred but was well tolerated. With paralyzed animals, whose ventilation was supported by a self-inflating bag with 10.0 L/min of oxygen, all hemodynamic variables except PAP returned to normal, oxygenation was excellent, and PaCO2 values were maintained at steady, but elevated levels. Complications included bilateral tension pneumothorax in one animal. This experimental study supports anecdotal experiences where PCMP has been used and has proven lifesaving when standard resuscitative measures to establish a clear airway have failed.

Airway Obstruction↗
PubMed1988

[Lung injuries caused by explosion in rabbits. 3. The behavior of the lung after injury].

The behaviour of the pulmonary activity was investigated in 30 rabbits after a blast. The estimation was carried out by the results of volumetric, gasometric, and radio-isotopic researches. The results show a considerable disturbance of the pulmonary activity which leads to respiratory insufficiency in rabbits after a blast of medium strength. The restriction type was dominant in the disturbance of the ventilation. An impairment of the gas diffusion is the consequence and leads to hypoxia and to a compensated respiratory acidosis.

Animals↗
PubMed1988

Sleep apnoea syndrome in pregnancy: a case report.

A case of sleep apnoea syndrome in a pregnant patient is reported here. For obstetric reasons, and because of the possibility that a metabolic and respiratory acidosis associated with the apnoea syndrome might have developed, we decided to do a caesarian section. Orotracheal intubation was particularly difficult because of the patient's abnormal mandibular, palatal and retropharyngeal shape, which was probably the underlying cause of the apnoeic syndrome.

Adult↗
PubMed1988

[Delayed intracerebral hemorrhage following VP shunt operation].

Three cases of communicating hydrocephalus after subarachnoid hemorrhage are reported that underwent ventriculoperitoneal shunt and suffered from delayed intracerebral hemorrhage along the ventricular catheter. Ventricular catheters were inserted into the posterior horn with minimal brain damage by our method, in case 1 and 2, 3 times try of ventriculostomy, in case 3, replacement along the same route on the shunt revision. Blood pressure control after the operation was good and bleeding tendency was not observed. Vascular anomaly was not found in preoperative angiography in any case. In case 1, 60 year-old man, intracerebral hemorrhage occurred on the 7th-9th postoperative day as the result of respiratory acidosis and generalized convulsion which needed assisted ventilation for two days. In case 2, 54 year-old man and case 3, 59 year-old woman, headache and hemiparesis suddenly developed immediately after micturition 4 days after operation. Postoperative CT scan revealed that cranioplasty, performed at the same time as shunt operation, caused mass effect on the shunted side of the brain in case 2. In case 3, VP shunt system revised did not seem to function so well. These conditions might predispose the shunted brain to bleed, in addition to the increased intracranial pressure or blood pressure probably produced by Valsalva effect at micturition. These cases indicate that the small surgical wound in the brain induced by shunt procedure could cause progressive degenerative vascular change and bring about delayed intracranial hemorrhage under some predisposing factors.

Cerebral Hemorrhage↗
PubMed1988

Pain scores and ventilatory and circulatory sequelae of epidural morphine in cancer patients with and without prior narcotic therapy.

Pain scores and respiratory and circulatory sequelae of epidural morphine were studied in 25 patients with cancer, classified into two groups: 15 with and 10 without a history of previous narcotic analgesic therapy. Morphine, 2.5 mg initially and 5.0 mg 12 hours later, was given through an indwelling lumbar epidural catheter. Pain scores, heart rate, blood pressure, respiratory rate and minute volume, arterial PO2 and PCO2, and arterial pH were measured for 24 hours. Both groups had the same degree of analgesia after each epidural dose, suggesting that local morphine concentrations seen with epidural administration may be sufficient to overcome any degree of tolerance that may have developed at the spinal level during previous systemic narcotic administration. Statistically significant dose-dependent hypoventilation and concomitant respiratory acidosis were seen in both groups, the changes being significantly greater in opiate-naive patients. These results demonstrate that the ventilatory depressant actions of opioids are attenuated but not eliminated in narcotic-familiar cancer patients and that epidural narcotics are as effective in relieving pain in narcotic-naive patients as in patients previously exposed to narcotics for relief of cancer pain.

Adult↗
PubMedDate not supplied

Therapeutic hyperbaric oxygen: help or hindrance in burn patients with carbon monoxide poisoning?

Although its efficacy is unproved, administration of hyperbaric oxygen (HBO) for the treatment of carbon monoxide poisoning is often carried out to prevent the development of acute and delayed neurologic sequelae. In burn patients with carbon monoxide poisoning the value of HBO also is unproved. This review of the clinical course of ten such patients showed major complications during the course of treatment: two patients suffered from eustachian tube occlusion, two patients had episodes of aspiration, one patient had seizure activity, and severe hypocalcemia developed in another. Progressive hypovolemia was seen in three patients; respiratory acidosis was evident in four. There were three episodes of cardiac dysrhythmia. Seven of the ten patients survived. The authors state that the efficacy of HBO in carbon monoxide poisoning must be studied further. Based on their experience and a review of the literature, they contend that important delayed neurologic sequelae are rare, and further, that they occur and resolve with or without HBO. Multicenter randomized clinical trials with controlled follow-up are needed to assess the actual incidence of neuropsychiatric sequelae and to evaluate the efficacy of HBO.

Adult↗
PubMed1987

[Acid-base equilibrium in calves with enteritis].

Studied were the indices of the acid-alkaline balance and the lactate level in a total of 19 Black-and-white calves manifesting clinical forms of enteritis as well as in 10 clinically normal calves that belonged to the same breed. In most of the calves affected with enteritis the blood pH values proved essentially lower than those found in normal calves. Differences were established between the normal and the diseased animals with regard to ABE, HCO-3, and pCO2, the ABE values with some of the animals with enteritis reaching -9.2 mmol/l, and the HCO-3 values--up to 16.5 mmol/l. Enteritis animals also showed higher pCO2 values than normal ones. The differences observed in the acid-alkaline balance pointed to the presence of metabolic respiratory acidosis in calves with clinical enteritis.

Acid-Base Equilibrium↗
PubMed1987

Circulatory effects of isoflurane during acute hypercapnia.

Acute respiratory acidosis results in increases in cardiac output and in systemic and pulmonary arterial blood pressures. The aim of this investigation was to determine if isoflurane modifies these effects. Nine patients (ASA II or III) scheduled for major surgery took part in the investigation. After the induction of general anesthesia, CO2 was added to the inspiratory gas mixture. After 15 min, ventilation with addition of CO2 (PaCO2 8-9 kPa) isoflurane (3%) was added. Hemodynamic measurements were made to study the effects of acute hypercapnia and the effects of isoflurane during hypercapnia. The addition of carbon dioxide resulted in increases in cardiac output, systemic and pulmonary arterial blood pressures, and right and left ventricular stroke work. The addition of isoflurane during hypercapnia decreased systemic arterial blood pressure, but pulmonary arterial blood pressure was unaffected, cardiac output and stroke volume did not change, and left but not right ventricular stroke work decreased. In conclusion, acute pulmonary hypertension induced by hypercapnia was not affected by isoflurane but, despite increased right ventricular stroke work, there were no signs of right ventricular failure.

Acute Disease↗
PubMed1986

Anesthesia in Göttingen miniature swine used for experimental surgery.

This contribution describes a modern technique of producing general anesthesia in the Göttingen minipig. The method of anesthesia selected is dependent on the duration and type of surgery. The drugs used to produce anesthesia should not interfere with the experimental aims, therefore only drugs with well known actions and a standardized anesthesiological procedure should be used. Climazolam, Ketamine and atropine are preferred for induction of anesthesia. After endotracheal intubation, inhalation anesthetic mixed with oxygen and nitrous oxide is used to maintain general anesthesia. Controlled ventilation is necessary to prevent the animals from developing respiratory acidosis. Postoperative analgesia is provided by orally administering acetylsalicylate or morphine-sulfate pentahydrate at 12 hour intervals.

Anesthesia, General↗
PubMed1985

Temperature and ventilation after hypothermic cardiopulmonary bypass.

Rewarming in the postoperative period after hypothermic cardiopulmonary bypass is often associated with hemodynamic and ventilatory instability. Temperature changes, PaCO2 values, and delivered mechanical ventilation were observed for the first 12 hr in the intensive care unit in 73 patients who had undergone cardiac surgery with hypothermic cardiopulmonary bypass. Mean rectal temperature increased from 34.7 to 38.3 degrees C over the first 8 hr after admission to the intensive care unit (P less than 0.001). The temperature curve was sigmoid rather than linear, and the most rapid rate of temperature increase occurred 2-4 hr after admission. During rewarming, the most common abnormality of PaCO2 on mechanical ventilation was acute respiratory acidosis (PaCO2 greater than 45 mm Hg, pH less than 7.35), which occurred in 42% of patients. This suggests that ventilatory management in the early postoperative period after hypothermic cardiopulmonary bypass should be carefully adjusted to the increased metabolic rate during rapid rewarming.

Acid-Base Imbalance↗